System for maintenance and management of health

ABSTRACT

A Mobile Tele-Medical Maintenance system (MTMM system) applying different IT methods to perform different functions for the tele-medical maintenance of large numbers of individuals. The MTMM system includes a system kernel residing on web servers, linked to a large number of peripheral units on the individuals. The kernel containing the collection of all the “Private Medical Web Sites” and “Personal Health Plans” of the individuals. The MTMM system periphery including walk-in care offices and intelligent physio-logical sensors that can communicate directly with the kernel&#39;s programs via the Internet or similar communication networks, preferably using the user&#39;s phone and its traditional interfaces, message display plus message voice, and push-button plus voice input. The system kernel controlling directly actuators in the periphery and using message display and message voice output of the telephone to interact with the individual.

FIELD OF THE INVENTION

[0001] The present invention relates generally to systems formaintenance and management of health for individual patients withCommunication Systems for remote monitoring and controlling of largecollections of individuals, persons or devices, and to ArtificialIntelligence for managing and maintaining their good status andtrouble-free operation.

BACKGROUND OF THE INVENTION

[0002] In most western societies, namely in the United States andEurope, more than 30% of the population do have serious chronic healthproblems that challenge them in any aspects of their daily work life,and even more and worse when they leave their home to go on travel, ortry to do some sports for their health. The annual medical cost in theU.S. have soared to more than 10,000 $ per non-healthy person. To bringdown and control these costs, home healthcare and preventive healthcarehave been launched and promoted by insurers and politicians, deliveredby mostly small local care givers spread out over the country. Thesuccess of these programs was expected to be significant, especiallywhen modern tools and methods of communication were designed, asdescribed in earlier patents for different, interactive and interestinghardware systems and electronic data processing or EDP methods.

[0003] But all these efforts ran against the fact that life expectancyclimbed faster than any corrective measures. Sooner or later it will addall of us to the group of persons who have to be constantly monitored.In these modern societies we mostly live single on our own with no matein the home. And any retired people's home will only accept us, if wecan still move around freely and do not have to stay and to be served inthe bed all the time, because the next weakness or dizziness can not bepredicted or immediately assessed and reacted upon.

[0004] Many tele-medical systems have been designed and described in thevery details, but have not really been used wide-spread and have notcontributed to successful optimization of cost and services. Main reasonfor this is the limited application of existing technology in hardwareand software by the medical caregivers and therefore only a limitedrange of services are conceived and delivered.

SUMMARY OF THE INVENTION

[0005] Accordingly, an object of the invention is a system for themaintenance and management of health which permits an easy and completeaccess to all important data of the patient to be treated.

[0006] This object of the invention is accomplished by a system with thefeatures of claim 1.

[0007] The main advantage of the system according to the presentinvention is that all important data can be retrieved immediately at anyplace. So the caregivers like medical doctors, first-aid men andemergency services can immediately decide which treatment or therapyshould be given.

[0008] In systems used for the management of large industrial plants,e.g. to control and maintain large oil refineries, or systems formonitoring remote pump stations along pipelines latest sensor technologywith high-speed communications and extensive Artificial Intelligence inthe central supervision stations, are known for over 20 years. Repairand preventive maintenance cost have been reduced to lowest optimizedlevels, while at the same time availability of the very complex plantswas pushed up and can be guaranteed today to 100% over 30 years.

[0009] It was surprisingly found that the functions to be implemented inefficiency optimized health maintenance of large groups of individuals,spread over rural countryside are very similar to above mentionedmanagement systems, that secure the safe and efficient operation of allthe installations in a large metropolitan subway system. The medicalmaintenance system according to the present invention now combines theadvantages of usual medical sensors and well-trained medical personnelin hospitals, doctor's offices, wide-spread walk-in stores and emergencyservices with the leading technical maintenance intelligence, with themost efficient and most widely used, traditional communication tool, thetelephone.

[0010] These and other advantages of the invention are disclosed in thedependent claims and the following description in which an exemplifiedembodiment of the invention is described with respect to theaccompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

[0011]FIG. 1 shows an overview of the elements of the present invention,

[0012]FIG. 2 shows a basic program module for monitoring andsupervising,

[0013]FIG. 3 shows another module for assessing and decision making, and

[0014]FIG. 4 shows several medical sensors connected to a mobiletelephone for communication with the maintenance and management system.

DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS

[0015] In the following description we define as ‘Patients’,‘Individuals’ and ‘Units’ the individuals and the large number ofdistributed entities to be monitored, managed and maintained. They allhave as a main property, their ‘Condition’, defined by the physiologicaldata and measured through different parameters. We call ‘Walk-ins’ thedevices, doctor's offices and labs, that measure and collect the‘Condition’ data from the ‘Patients’ by ‘Sensors’ and feed the measureddata into the management system.

[0016] We call ‘Managers’ the programs and ‘Supervisors’ and‘Caregivers’ the persons who are in charge of the ‘Condition’monitoring, like doctors, first-aid men and emergency services, whichreact on ‘Events’ defined as alarms, problems and the like. We call‘Resources’ all the man hours, money, people, devices, energy andconsumables or disposables used and spent for treatment,troubleshooting, assistance and for teaching and maintenance of the‘Units’.

[0017] We call ‘Logs’ all the electronically organized and recordedinputs of measurements, actions, notes and results. And finally we call‘Reports’ all the information gathered over the whole time and compiledon different purposes to satisfy general and specific information needs,from administrative functions to strategic fact-finding anddecision-making.

[0018] MTMM System Overview

[0019] In FIG. 1 a platform of the Mobile Tele-Medical MaintenanceSystem (MTMM) is depicted, which is a computer system with a combinationof proven technology process control modules, hardware and software,with a known medical knowledge base, linked via the Internet 10 and withthe telephone as communication net as backbone to the distributedperipheral entities. The system kernel consists of several largedatabases 11 containing all the relevant data of all Patients andResources: A ‘Personal Medical Web Site’ contains the data in form of anEMR (‘Electronic Medical Record’) which is stored in a Condition Log inone of the databases 11. At the other hand the access to the EMR can beobtained via an Internet link. The system kernel resides normally on webservers and is linked to a large number of peripheral units on theindividual patients.

[0020] A ‘Personal Health Plan’ shows all the doctor's prescriptions andrecommendations to the Patient for medication, eating, physicalactivities, lifestyle, telephone calls to the doctor's office, etc. andthe selected Condition monitoring with threshold values or limits andindications for corrective actions to caregivers should any values orlimits be exceeded.

[0021] A further database 12 collects all the Condition measurementsmade and Event messages received, together with all the correctiveactions or reactions taken and initiated by the Manager programs and theSupervisors and Caregivers, and links them to Cases, Users and Resourcesin a Shift Log. Also the Personal Health Plan is linked to the ShiftLog.

[0022] The databases 11 and 12 are connected by and communicate over aninternal network or intranet 13 with each other, directed by Managermodules 14 and Supervisors and Caregivers 15.

[0023] The kernel is surrounded by the peripherals, linked to thedatabases and the Manager Modules via the Internet: All the Patients,shown as ‘Mobile Hearts’ 16, the Walk-ins 17, the Caregivers 18 andemergency services 19. These peripherals have many ways to enter theirCondition data into the databases, using e.g. smart Sensors, labinstruments and PC's, alarm buttons and help-phones, or just ‘manual’typing or voice input in plain text on a terminal. Also scanners can beused to enter handwritten information, which can be transferred tomachine-readable information by a known transposing program, into thedatabases 11.

[0024] Log Manager Module

[0025] In FIG. 2 a Log Manager Module is shown, which is the basicprogram module of the MTMM system, doing Condition Monitoring andSupervision. All Conditions, i.e. measurements, alarms and other inputs,and Events 21 are entered and logged into the databases. All thenecessary links 22 to Personal Health Plans are updated, enabling fastretrieval and augmentation of knowledge stored in a knowledge database.

[0026] The Log Manager Module as a condition monitoring device assessesthe data entered and, if preset limits or trends 23 have been exceeded,automatically generates alarms 24 to Supervisors, Caregivers, Patients,emergency services and other medical personnel on duty. Based on thedoctors prescriptions 25 and case classifications 23 the Log ManagerModule initiates calls by doctors, visits by Caregivers, medicationchanges by pharmacies, device exchange and maintenance by technicians,etc.

[0027] The Log Manager Module sends the orders 26 for these correctiveactions also to the human shift Supervisor who may then decide onpriorities and may coordinate the actions. The Log Manager Module keepstrack of all the related events, of his own actions and initiations, ofthe Supervisors decisions, of the actions and the results feedback 27,in a fully integrated Shift Log 28.

[0028] It is a main characteristic of the MTMM system that all the taskscan be and some have to be executed in parallel by the software ManagerModules and the human Supervisors.

[0029] The Log Manager Module is an excellent tool for any shiftsupervision 29, also for medical supervision. No handwritten notes arenecessary, all important events are always present and can be calledupon directly on-screen. The planning of shifts in care giving, inemergency telephone services, for ambulances and for hospitals, etc.becomes “easy” to manage.

[0030] Diagnostic Manager Module

[0031] In FIG. 3 the Diagnostic Manager Module as an evaluating deviceis shown, which is a ‘knowledge driven brain’ of the MTMM system, doingthe assessment of Conditions and Events, taking decisions and makingrecommendations to the Caregivers and the Patients for troubleshootingand treatment and keeping record of the results 35 of each action.

[0032] In response to alarms 31, Condition measurements 32 anddescriptions 33 of problem situations, the Diagnostic Manager Moduleenables Supervisors, Caregivers, emergency technicians and Patients toassess the situation 34 and to identify the appropriate correctiveaction quickly and accurately. This module, applying usual softwaretechnologies, combines actual ‘best-practice’ diagnosis guidelines witha unique knowledge base from the electronic Shift Logs 36, learning andacquiring new knowledge 37 continuously.

[0033] With this knowledge always recallable from the DiagnosticManager, all the Supervisors, Caregivers, emergency and shift staff arelearning continuously on their job 38, reducing cost of trainingsignificantly and improving the quality of their service. Internet-basedteaching can be included, linked and added to the recommendedprocedures.

[0034] Health Plan Manager Module

[0035] This is the first program in the ‘Maintenance Control Cycle’ andit enables the Caregivers to tailor-made their ‘Teaching and Treatment’service to the Patients' individual needs, while optimizing thedeployment of their resources and reduce the cost generated. But it isalso the follow-up program that enables the Caregiver and the Patient toadjust their efforts and to optimize the deviation of the Condition from‘best practice’ accepted standards for the Patient's sex, age,population group, job, education, activity, etc.

[0036] All Teaching, Treatment, medications, activities, Conditionmonitoring parameters with devices and actions are managed and displayedto Caregiver and Patient in a Health Plan (or Disease Management)classification system. All the different sources of services (doctors,walk-ins, care givers visits) and their care and assistance given,planned and unplanned, are selected and implemented in this ‘PersonalHealth Plan’. For this task the Health Plan Manager Module bases on theCaregivers experience and ‘best practice’ guidelines but also on allcompany internal rules and ISO certified standards.

[0037] The ‘Personal Health Plan’ keeps the overall picture of all theservice efforts done and the resulting Condition, summarized into anintegral history of the Patient's health. Transitions in his ‘medicallife’, by going to the hospital, being released to a nursing home,moving to another area and another family doctor, changing job andhealth insurance, etc. can be managed without transferring the patientsdata in a old-fashioned, cumbersome way. In the MTMM system the ‘MobilePatient’ can really leave home ‘without it’ and access his ‘PrivatePatient Web site’ and his ‘Personal Health Plan’ from any place in thisworld, while still being monitored, supervised and assisted like in hishome town.

[0038] Service Manager Module

[0039] This is the module for the Caregiver's logistics organization. Itenables them to monitor and optimize their highly complex, distributedand costly operations. It manages the collection of all servicecontracts and doctors prescriptions. It controls all preventive care andunscheduled troubleshooting events, and includes them into a “integral”care cycle. It allows regular preventive care work to be scheduled,planned, ordered and monitored down to the smallest consumable needed.

[0040] All services, all devices and Resources are recorded and managedin a parts classification system. This system includes all necessaryinformation about suppliers, contracts, equipment and warranties. Thesame way all the patients and the care, planned and unplanned, aremanaged in the Health Plan Manager, the same way all peripheralentities, Devices and Resources, are maintained ready and in goodcondition. For this purpose the Service Manager Module also contains allthe information according to ISO standards and company internal rulesand specs.

[0041] While the care givers work is performed, all data about type ofservice, problems solved, how, with which medication and material and atwhat cost, are entered and a special Care Service Report is generated.Findings, conclusions and actions taken are then transferred to theDiagnostic Manager's knowledge data base.

[0042] Report Manager Module

[0043] This is the evaluation and analysis program for the management ofthis fully integrated Health Maintenance Process. It enables continuousand periodical monitoring and classification of the activities in theelectronic Shift Log, in the service orders and in other Events. Thismakes transparent the patients and population group's proneness toproblems just as well as the cost control, hours spent and medicationand consumables used.

[0044] The Report Manager Module enables monitoring the compliance ofthe therapies implemented and the outcome of the therapies administered.It therefore delivers the basis to all measures to improve efficiencyand quality of the Care-giving process (‘Teaching and Treating’)throughout the whole service industry and its market.

[0045] All the data bases are of the relational type, based on standardsoftware. It therefore is easy to add report generators to createadditional, custom made reports, as well as to implement interfaces tosophisticated Management Information Systems.

[0046] Peripherals Integration

[0047] In FIG. 4 the integration of peripherals is depicted. The MTMMsystem uses the open architecture of Internet, telephone and the socalled ‘RF-Piconet’, which finally enables a full integration of alltypes of peripherals via the easy to use, omnipresent telephone link, bywire and wireless.

[0048] The telephones, mainly the new mobile phones (also built intoother devices, like watches, palm PC's), shall become the favorites inpersonal medical condition monitoring. Installing and assigning newperipherals is easy: New users get their phone with a world-wide privatenumber (=device address). They can use it where ever they are and whatever telecom company's infrastructure they are based on.

[0049] The new mobile phones have become real Internet terminals, withwhich huge amounts of information can be downloaded and displayed, ifnecessary. They are used in the MTMM system as hubs for the very smallnetwork of different intelligent Sensors on the Patients body anddevices nearby in the home, the “Piconet” 43. The mobile phone can pollCondition data from the Sensors, display them, pre-assess them andtransmit them on to the databases in the kernel. And all Users have beencomfortable for a long time with the user-friendly guidance “if you needassistance, press 0” and will also get used to high-tech voice input andvoice recognition.

[0050] In most urban areas the mobile phone system enables tracking ofthe Patient's position down to some 50 m accuracy, an ideal tool for anyEmergency Medical Service but also for caring friends and familymembers.

[0051] The Sensors have become ‘intelligent’ and can communicate overthe same Internet with the central Log Manager Module. In the MTMMsystem they download requests and limits for bio-signal acquisition andtransmission and do the Condition monitoring. They can do basicpre-assessments of the bio-signals and can give local alarms to thePatient, if limits are exceeded. They integrate RF-Piconet transceivers(like Bluetooth) that enable them to start communication with any otherdevice, when ever they are switched on.

[0052] The MTMM system performs thus the functions of “CSACT”: Conditionmonitoring, Supervision, Assessment, Communication, Treatment andTeaching. It applies different methods of signal analysis in theintelligent sensors and in the kernel to assess the actual status of theindividuals, it communicates the assessment to diagnosing programs andsupervisory personnel and commands the actuators, assistance personneland the individual to treat itself and to cope with the actualsituation. Using standard and Artificial Intelligence software the MTMMsystem will do : Alarms, immediate corrective actions, reports, logsincluding accounting; recalls to care providers, optimized plans forpreventive check-ups and care; optimized management of all personnel,material, devices and infrastructure resources of the care givers; allsorts of statistics for any level of the medical hierarchy in politics,public and private health organizations and insurers.

[0053]FIG. 4 shows such a typical ‘Piconet’ 43 in the MTMM system: amobile telephone 41 with its display 42 and special display controlbuttons 44, its numeric keypad 45 in order to type in values fromstand-alone tests, speaker and microphone for voice output and input 46.The mobile telephone 41 communicates with any server on the Internet andits built-in RF-Piconet transceiver 47 communicate with two Sensors onthe Patients body, and with one tabletop device.

[0054] A heart monitor 50 senses the ECG with two electrodes 48,pre-analyzes it and stores it on a memory-card 49. It also monitors thebreathing rate and breathing volume by breath sensors 52. The measuredvalues are stored and checked for coherence between two normallyindependent signals. The heart monitor 50 uses the display 42 of themobile telephone 41 to show to the patient locally his Condition withheart-rate, body temperature, breath rate and breath volume. The mobiletelephone 41 transmits further the Condition data over the Internet 53to the MTMM system and to its Log Manager Module. The heart monitor 50and mobile telephone 41 may communicate continuously or periodicallywith each other, or only in case of alarms or exceeding of limits.

[0055] A non-invasive blood pressure unit 55 is used only a few times aday, according to the doctor's request. So are many other devices; whenever they are taken out of the pocket and switched on, theyautomatically search over transceiver 47 the area for an active‘Piconet’ to hook on. The RF-Piconet transceiver 47 (like Bluetooth)offers this type of network, like the wire-bound Ethernet.

[0056] A glucose meter 56 might be of the old fashioned strip type. Witha built-in RF-Piconet transceiver 47 it will automatically call the MTMMsystem via the mobile telephone's access to the Internet 51 and will askfor Condition measurement schedules. If it does not have the networkcapability, the MTMM system will request the Patient via the mobiletelephone's display 42 to do a measurement at the prescribed time and totype in the resulting value via the numeric keypad 45 of the mobiletelephone 41.

[0057] It should be clear to the skilled person that instead of mobiletelephones 41 also normal telephone sets or PC's with a monitor can beused.

[0058] Built-in data conversion modules in the Log Manager Module allowdefined alarm and condition data formats to be transferred directly intothe database. The Supervisors can assess the individual patients status‘real-time’ by calling their mobile phone's “Pico-net”hub.

[0059] But also the devices leased and maintained by the Caregiver, bythe ambulances and by medical personnel can be called and directed in‘real-time’. The logs of their deployment at the same time aretransferred to commercial bookkeeping and invoicing systems within thecompany offering useful and efficient support not found in othersystems.

[0060] Standard Hardware and Software

[0061] The system is standard-based, running on Windows and Unixplatforms. The databases are all relational. The system is also modular.The individual modules can be used independently of one another.

[0062] The favorite network, fully exploiting the new WAP (WirelessApplication Protocol) capabilities, is the worldwide Internet, or anIntranet in large companies, hospitals, nursing home holdings, etc. Themobile telephone can control several sensors and input devices.Bluetooth is the future standard in these “Piconets”.

1. A system for maintenance and management of health care for individual patients comprising a computer system with a condition monitoring device, in which physiological data measured on the patient is transmitted, entered and stored together with alarm signals and event information of the patient into a Condition Log, a supervision device, in which the alarm signals and event information are assessed and which transmits the alarm signals and event information to care givers involved in order to initiate a corrective action on the patient and to request a report about the corrective action and its results, and in which the reports are stored into a Shift Log, and an evaluating device, in which problems and the patterns of the measurements are evaluated by comparing the problems and patterns with accumulated information in a knowledge database, thereafter selecting appropriate corrective action to be recommended to the caregivers and requesting a report of the caregivers about the corrective action and its results, which reports are entered into the database accumulating and enlarging the knowledge database, and a communication system connected to the computer system for transmitting alarms and recommendations to a supervisor, who corrects and/or releases the alarms and recommendations, which are transmitted further to the caregivers for taking the recommended action.
 2. A system according to claim 1, whereas the communication system comprises devices for Internet access, especially Internet accessible mobile telephones, PDA's and PC's.
 3. A system according to claim 1 or 2, wherein sensors are provided for measuring the physiological data on the patient which are connected to the communication system.
 4. A system according to one of claims 1 to 3, comprising a Medical Web Site stored in the computer system, which contains a separate database containing all medical data and the medical history of each individual patient, which is accessible by express authorization of the individual patient and/or his caregiver only.
 5. A system according to one of claims 1 to 4 comprising a Personal Health Plan stored in the computer system, containing the doctor's prescriptions for medication, treatments, practicing and lifestyle of the individual patient, a schedule for the monitoring of conditions stored in the Condition Log, the selection of sensors to be used, the threshold values of the physiological data to be monitored and corrective actions, whereas the monitored data, compliance for therapies and the outcome of the therapies are attached to the Plan, which is accessible by express authorization of the individual patient and/or his caregiver only.
 6. A system according to one of claims 1 to 5 comprising a Log Manager Module for monitoring the alarm signals and the event information in the Condition Log and for supervising the reports in the Shift Log.
 7. A system according to one of claims 1 to 6, comprising a Diagnostic Manager Module for diagnosing the condition of the individual patient by means of comparing data stored in expert computer programs containing diagnosis guidelines with the accumulated data of the knowledge database. 